Pharmac Update

Pharmac Update: Primary Care Prescribers for the week ending 28 October 2022 Paracetamol oral liquid brand change: Paracare and Paracare Double Strength The funded brand of paracetamol oral liquid high and low strength is changing.

Paracetamol - 250 mg per 5 ml • previous brand: Paracare Double Strength (1000mL) • new brand: Pamol (200mL), supplied by Aspen Pharma - funded from 1 November 2022.

Schedule restrictions The dispensing restrictions in place since 1 June 2022 to help manage the current stock levels will continue to apply to Pamol over the transition period, and will be reviewed at a later date. We will update our website with further details about this.

Paracetamol - 120 mg per 5 ml (200mL) • previous brand: Paracare • interim brand: Avallon – funded from 1 September 2022 • new brand: Ethics, supplied by Multichem NZ - funded from 1 January 2023.

He Ako Hiringa have developed a resource with additional information for healthcare professionals which can be found on the He Ako Hiringa website.

Both strengths of paracetamol oral liquid, as well as the currently funded ibuprofen liquid, are colour free. Therefore, when prescribing and dispensing, this similarity may need to be specifically highlighted to patients, whānau or caregivers. Both new brands are Medsafe approved.

People can learn more about this brand change through Health Navigator NZ. For more information please see Paracetamol oral liquid: Brand change - Pharmac | New Zealand Government.

Supply issue: Dulaglutide (Trulicity) Pharmac has been informed by the supplier of dulaglutide (Trulicity), Eli Lilly that there are supply issues with the diabetes medicine due to unanticipated increases in global demand and an out of stock of another supplier’s GLP-1 receptor agonist. This may mean Aotearoa experiences constrained supply until mid-2023.

Eli Lilly has committed to maintaining supplies of Trulicity at levels that will support existing patients already on treatment in Aotearoa. They tell us that, while the supply situation remains dynamic, existing patients in Aotearoa should be able to fill their dulaglutide prescriptions without interruption.

To safeguard stock for people currently using dulaglutide, we are asking health professionals to strongly consider not starting new people on this medicine. Pharmac is actively exploring all options

to minimise the impact on patients from this supply issue and we will continue to update patients and healthcare providers as further information comes to hand.

For further information please see Dulaglutide (Trulicity): Supply issue on the Pharmac website.

Supply issue: Pregabalin s29 alternative listed 1 November 2022 Aspen, who supplies Pregabalin Pfizer, has advised that due to manufacturer-level issues and freight challenges, its brand of pregabalin 25 mg and 75 mg capsules may be briefly out of stock towards the middle of November.

From 1 November 2022, an alternative brand of pregabalin 25 mg and 75 mg capsules, Milpharm, will be funded.

Milpharm pregabalin is not currently approved by Medsafe and will need to be prescribed and supplied under Section 29 of the Medicines Act. While not approved in New Zealand, this brand is approved and used in the United Kingdom.

We are working closely with Aspen to understand when this supply issue will be resolved, and will provide any updates on the Medicines Notices page.

Adalimumab brand change As of 1 October 2022, Amgevita is the main funded brand of adalimumab for all uses (current and new). All existing Humira Special Authority numbers have expired, and new Humira Special Authority criteria has come into place. If you have submitted a Waiver request for a patient to remain on Humira and it has been approved prior to 1 October, this has not been cancelled.

Post-1 October Humira Special Authority access criteria Repeat dispensings for Humira with an expired Special Authority will still be funded if the initial dispensing on that prescription occurred before 1 October.

Steps for prescribers: • Identify patients using adalimumab and discuss the continuation of their treatment with Amgevita • When discussing transitioning to Amgevita with your patient, you can complete an Amgevita Special Authority renewal application for the appropriate indication, even if the initial number has expired. Fill this in based on the patient’s current clinical condition on adalimumab (either Humira or Amgevita) • For patients who require ongoing funded access to Humira after 1 October, a new initial Special Authority must be completed • Ensure you prescribe adalimumab by brand (either Amgevita or Humira) Further information will be available on the Pharmac website. Resources to support you and your patients with this change can be found at amgevita.co.nz

Supply issue update: Docusate sodium with sennosides (Laxsol) tablets and other laxatives

The Laxsol supply issue was caused by a lack some of the raw materials used to make the product.

This issue also affects Coloxyl.

Back orders are cleared, and some stock remains in the supply chain. The next shipment is due early November. Both the supplier and Pharmac are aware of the critical nature of this product.

Other Laxatives: Supply issues We understand that Laxsol supply disruption is leading to knock-on stock shortages for other funded laxatives.

Konsyl-D and the alternative we listed, Macro Organic Psyllium Husk, are out of stock. The next shipment of psyllium husk due in New Zealand in early November. Resupply date for Konsyl-D is December 2022. Senna (Senokot) is out of stock. We are advised that the next shipment will arrive in New Zealand in early December 2022. Stocks of Micolette are low, with new section 29 stock arriving soon. It will take time for stock to make its way through the supply chain to individual pharmacies once it arrives in the country.

We are working closely with all suppliers concerned to speed up freight to Aotearoa where possible, or to find alternative products.

Our expert clinical advisors suggest that there may be suitable alternatives, including macrogol-3350 sachets (Molaxole) and lactulose. Where appropriate, please consider using alternatives while this supply issue persists.

Further information is available on the Pharmac website.

Citalopram 20 mg: Brand change As of October 2022, a new brand of citalopram, Celapram, was funded. The current supplier, API, is leaving the New Zealand market and their PSM brand of citalopram is no longer being manufactured.

PSM citalopram is expected to begin running out in December 2022. People using PSM citalopram will need to change to Celapram sometime before December 2022 to continue to access funded treatment. From 1 March 2023, Celapram will be the only funded brand of citalopram.

The new tablets will look different, but the tablets have the same active ingredient and work in the body the same way as the currently funded citalopram, PSM citalopram.

We know that moving people from one brand to another can be difficult. To support this, we are covering the cost with a brand switch fee. This will be in place from 1 March 2023 to 1 June 2023.

Further information is available on the Pharmac website.

Morphine ampoule: Brand change The funded brand of morphine sulphate ampoules is changing from DBL Morphine Sulphate to Medsurge as a result of our annual tender process. We expect stock of DBL Morphine Sulphate to begin running out some time in December 2022. The Medsurge brand has been listed in the Schedule from 1 October, and both brands will be funded until March 2023.

Packaging of the Medsurge brand will look different. Both brands of morphine ampoule use colour coding to differentiate between strengths, and the colour coding is not the same between brands.

The Medsurge individual ampoules will also be colour coded, matching the corresponding packaging.

The Medsurge 15 mg per mL and 30 mg per mL ampoules have similar shades of brown colourcoding on the packaging and individual ampoules. Attention is required to ensure the correct strength is chosen for administration.

He Ako Hiringa have developed an educational resource to support healthcare professionals with this brand change: Morphine ampoules | He Ako Hiringa Further information is available on the Pharmac website.

COVID-19: Information for prescribers Evusheld: Available to be administered in general practice From 3 October 2022 Evusheld (tixagevimab with cilgavimab) is available for community supply and primary care administration to those who meet Pharmac’s access criteria. Evusheld is used for COVID-19 pre-exposure prophylaxis.

Guidance on Evusheld and its use is available on the He Ako Hiringa website and Ministry of Health website.

Updated Access Criteria Check the Pharmac website to view the COVID-19 access criteria. Always check the criteria before prescribing as updates may have been made.

Pharmac website – COVID-19 oral antivirals: Access Criteria You can read all about the available and soon to be available COVID-19 treatments on our website.

Aotearoa's COVID-19 treatment portfolio COVID-19 antiviral Access Criteria assessment tool Use the online tool to help identify who’s eligible for funded COVID-19 antiviral treatments.

Access Criteria Assessment Tool Managing supply of other medications Please prescribe normally and encourage patients not to stockpile medicines.

Pharmac, pharmacies and suppliers are working closely to maintain medicines supply, and to minimise disruption and fairly distribute any medicines in short supply.

More information about Pharmac’s response to COVID-19 is available on the Pharmac website.

Promethazine hydrochloride (Allersoothe) Oral liq 1 mg per ml We've been alerted to a supply issue with Allersoothe. The supplier still has some product available.

However, an out of stock is possible due to a delay in the release of the next batch.

This issue only affects the oral liquid. The Allersoothe tablets are unaffected by this supply issue. We recommend pharmacists try all the available wholesalers if they have trouble accessing stock from their usual wholesaler.

Further information is available on the Pharmac website.

Lisinopril 5, 10 and 20 mg tablets: New look Earlier we advised that Teva is changing their brand from Ethics Lisinopril to Teva Lisinopril. All strengths of Teva Lisinopril are now in the supply chain. We are advised that the Ethics brand will likely run out by mid to late November.

Further information is available on the Pharmac website.

Amoxicillin with clavulanic acid: Supply issue Sandoz, the supplier has advised that there is a temporary delay to the supply of Curam Duo 500/125. Supplies are being released at the end of October 2022. Supply is expected to return to normal by late November.

Further information is available on the Pharmac website.

Nutricia foods products: Supply issue affecting multiple products Most of the supply issues affecting Nutricia special foods products have been resolved. There will however continue to be supply issues for some products throughout 2022.

Check the Pharmac website regularly for updates on products.

Get involved with the test-and-treat programme to help eliminate hepatitis C Approximately 40,000-45,000 New Zealanders continue to live with chronic hepatitis C even though an effective treatment called Maviret has been funded since February 2019.

Hep C can now be diagnosed with a quick and easy finger prick test.

Ministry of Health are looking for more GP practices to be part of the testing programme. Contact your local coordinator to learn more about taking part.

Hepatitis C regional coordinators Region Northern Region: Te Manawa Taki (Midland) Region Central Region South Island Region

Co-ordinator Leanne Kirton Jo de Lisle Caitlin Robinson Rob Hallinan

Email Leanne.Kirton@nra.health.nz Jo.DeLisle@healthshare.co.nz Caitlin.Robinson@tuora.org.nz Rob.Hallinan@cdhb.health.nz

Phone 021 318 295 027 549 2122 027 700 5945 027 213 8104

Keep up to date on supply issues and brand changes Pharmac regularly updates its website with information about changes in brand and any current or emerging supply issues.

You can find information about current issues on the Pharmac website.

We want you! Expressions of Interest for Pharmac’s Advisory Committees Pharmac is looking for new members for our Advisory Committees. Do you work in primary care and bring a commitment to and understanding of te Tiriti in healthcare? We are particularly seeking to appoint General Practitioners to a number of our Advisory Committees to provide input from the primary care perspective.

Pharmac’s Advisory Committees provide us with specialist knowledge and expertise within specific clinical areas, such as diabetes, cancer, and mental health. Advisory Committees usually meet once a year, but maybe more or less frequently. You can find more information about Advisory Committees roles and responsibilities on the Pharmac website.

If you are interested in being involved in Pharmac’s clinical advice network, please send an email to advisorycommittees@pharmac.govt.nz letting us know your specific clinical area(s) of interest.